Analytical Cross Sectional study to assess the Effectiveness of Bowel Anastomosis using Double Layered and Single Layered Closure

Sukumar, R (2019) Analytical Cross Sectional study to assess the Effectiveness of Bowel Anastomosis using Double Layered and Single Layered Closure. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: “Bowel resection and anastomosis have been done for many number of cases including bowel obstruction, perforation, gangrene, malignancy etc. In conventional technique, by applying double layered sutures, it causes narrowing of the bowel lumen and causes great tissue strangulation. The technique for single layered closure is simple, easy, takes less time, and uses less suture material than the conventional method. This technique also theoretically provides better post operative condition in which bowel anatomy and physiology can return to normal earlier, causing minimal tissue trauma and less narrowing of the lumen. “Hence in this article, patients with bowel anastomosis using these two techniques are compared and to see which technique is better for patient’s safety. AIMS AND OBJECTIVES: “To compare the results obtained from these two techniques and to asses the bowel’s ability to regain the continuity after anastomosis using two different methods of suturing. MATERIALS AND METHODS: Place of Study: Department of General Surgery, Government Stanley Medical College and Hospital, Chennai. Sample Size: 50. Duration: 12 months. Study Design: Cross sectional study. Inclusion Criteria: All patients who underwent laparotomy with bowel anastomosis. Exclusion Criteria: Patients with comorbidities like diabetes, Tuberculosis, steroid abuse. Patients with colo rectal anastomosis where the access is very restricted. METHODOLOGY: Written informed consent will be obtained from the patients undergoing the procedure. The patients with laparotomy and bowel anastomoses using these two techniques are included in this study. During follow up, patients are divided into a control and test group. Control group patients are those who had two layered bowel anastomosis using vicryl (polygalactic acid) where the continuous sutures have been taken extramucosally as a first layer and then reinforced by suturing seromuscular layer across the previous one using silk as a second layer intermittently. Test group patients are those who had single layered bowel anastomosis using vicryl where extramucosal sutures have been taken continuously as a single layer without any reinforcement. And the patients are followed. Observations are tabulated according to the predesigned proforma. The results are analyzed using Microsoft excel for tabular transformation and graphical representation. For comparing the parameters, chi square test or fischer’s exact test are used. SPSS software will be used for statistical analysis. RESULTS: In my study the total population is 50. Among those 50, 25 were the patients who had single layered closure of bowel anastomosis and the other 25 were the one who had double layered closure bowel anastomosis. Regarding age distribution the largest population were between 51-60 years. Regarding sex distribution, male patients had more bowel anastomosis. Regarding diagnosis, ileal perforation was found to be the major cause for bowel resection and anastomosis. Post operatively during the follow up, patients records have been evaluated for many parameters like day of bowel sounds, passing flatus, stools and the duration of hospital stay. From this study it is found to be there is no difference in returning of bowel sounds in between the two groups (3rd post op day) But in case of bowel motility the day of passing flatus ( 3rd post op day for single layer and 4th post op day for double layer) and the day of passing stools (6th post op day for single layer and 7th post op day for double layer) is earlier in case of single layered closure than in double layered closure. And also the duration of hospital stay after the surgery (8 days for single layer and 10 days for double layer) is also found to be earlier in case of single layered closure than in double layered closure. And the p value is also highly significant for single layered closure anastomosis. CONCLUSION: Intestinal anastomosis has always been a crucial surgical skill for the surgeons and the main complication of anastomotic leak in the post-operative period is the nightmare of all the general surgeons and whenever it is present, it adds more morbidity and mortality for the patients. Keeping in view the lesser intra operative time, early attainment of bowel motility and the shorter duration of hospital stay for single layered closure of bowel anastomosis as compared to the double layered closure, it can be concluded from this study that the single layered closure is safe and better surgical procedure for bowel anastomosis than the double layered closure.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bowel Anastomosis, Double Layered and Single Layered Closure, Analytical Cross Sectional study.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 04 Sep 2019 00:28
Last Modified: 04 Sep 2019 00:28
URI: http://repository-tnmgrmu.ac.in/id/eprint/11451

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